The Role of the Occupational Health Nurse

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The Role of the Occupational Health Nurse

Canada Bread & The Occupational Health Nurses Association of Nova Scotia Safety Services of Nova Scotia

26 March 2009 Jeannette E. Combes RN MN COHN(C) 2:00PM - 3:15PM Concurrent Sessions


Find out what ………

• One stop shopping for all your health,

wellness, environmental and safety needs - find out what an Occupational Health Nurse can do to help improve your bottom line and improve employee morale and productivity.


Learning Objectives

• Qualifications of the Occupational Health Nurse

• Discuss OHN Nursing & Independent Practice

• New knowledge & insights – Learning curves

• Define Primary Care

• Work place stress & the importance of work

• Discuss the different generations of workers in the workplace

• Occupational Health Nurses Traits


An Occupational Health Nurse is

• Registered Nurse licensed by CRNNS

• Professional with specialized education and experience

• User of nursing process and standards

• Able to work independently or in a team

• An initial referral source for employee health


Nursing Process

• Assess

• Plan

• Implementation

• Evaluation

• On going Evaluation


College of Registered Nurses of Nova Scotia

• Self governing nursing licensing body

• Have standards of practise.

• Core Competencies

• Self evaluation tool

• Annual renewal of licence


What can OHNs do?

• Assessment and case management

• Emergency response

• Health / Medical surveillance

• Vision / audiometry / spirometry screening

• Return to work programs

• Employee education

• Hazard identification / surveillance


What can OHNs do?

• Environmental auditing

• Employee wellness programs

• Employee Assistance Program development

• Workers compensation liaison

• Immunization programs

• Record keeping

• Epidemiology – Healthy Worker Effect


What can an OHN do?

• Programs evaluation

• Maintain confidentiality

• Safety committee resource

• Ergonomic program resource

• WHMIS / OH&S Act / First aid education

• Clinical monitoring


Where do OHNs Work

• Business / manufacturing / processing

• Government agencies / Departments

• Health care facilities

• Community health/Public Health

• Self employed / Consultants

• Offshore

• Insurance Companies: Case Management


When did OHN Nursing Begin?


Father of Occupational Medicine Bernardino Ramazzini”


Primary Health Care Providers

• Primary care includes health promotion, disease

prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and

chronic illnesses in a variety of health care settings (office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and managed by a trusted health care provider often

collaborating with other health professionals, and utilizing consultation or referral as appropriate


Primary Health Care Providers

• Primary care provides patient advocacy in the health care system and workplace to accomplish cost

effective care by coordination of health care services. Primary care promotes effective

communication with patients and encourages the role of the patient as a partner in health care.


Primary Health Care – OHN Nursing

• Primary care is that care provided by Trusted Health Care providers specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed or diagnosed sign, symptom, or health concern which maybe biological (environmental), behavioral or social in origin


Learning Curve for OHNs

• Independent/ Remote Practice

• Occupational Health Practice & Primary Care

• Reportable and recordable injuries,

• Components of industrial hygiene

• Workers Compensation Legislation

• Ergonomics

• Functions specific to health surveillance


Learning Curve for OHNs

• Occupational Health & Safety Act

• Occupational Safety Practice

• Toxicology

Environmental Risks to Health

Social & Behavioural Aspects of Occupational Health

• Men’s Health


Importance of Work

• Work is one of the most fundamental aspects in a person’s life, providing the individual with a means of financial support and, as importantly, a

contributory role in society. A person’s employment is an essential component of his or her sense of

identity, self-worth and emotional well-being.”

(Supreme Court of Canada 1987).


• Linda Blevins, an occupational health nurse with the Employee Health Clinic, checks blood pressure for Marta Collins, a family health nurse at Hall Health.

You can get your blood pressure checked at the Employee Health Clinic, too.


Work Factors Threatening Mental Health & Physical Safety (Shain 2001)

• Lack of status rewards

• Discrimination

• Harassment

• Poor communication

• Too little or too much responsibility

• Lack of influence over day to day work

• Work overload and time pressure

• Lack of training and/or preparation

• Ambiguity in job responsibility

• neglect of legal and safety obligations


Difference Populations Cared For

• Traditionalists – born prior to 1946

• Baby Boomers – 80 million strong 1946- 1964

• Generation X (1965-1981)– 46 million

• Millennial generation (1982-2000) 76 million strong


Baby Boomers (1946-1964)

• Like life in the fast line

• However they cannot run as fast as they use to

• Idealistic & and optimistic with many

responsibilities with aging parents & growing kids

• Like more time off – most valuable reward


Generation X

• Born in 1965-1981

• Major influence that shaped this generation was divorce

• Influenced by the explosion of media

• High independent and entrepreneurial

• Highly skeptical generation

• Lots of learning opportunities.

• Stimulating career. (Lancaster & Stillman, 2003)


Millennials (1982-2000)

• Digital generation

• Have had boomers as parents who have encouraged them to seek work that has meaning

• Technology

• Needed in work places at warp speed but not coming as fast enough.


Why are OHNs Cost Effective?

• Decreased sick leave

• Reduced cost of premiums

• Increased employee morale / productivity

• Increased experienced employee retention

• Testing / referral in-house

• Control of standards / consultants


Why have an OHN at your workplace?

• Generalist and referral source

• Employee advocate

• Negotiator

• Expert interpreter

• Future requirements


Program Planning - Assessment

• Health status of worker populations, such as nutritional status, exercise habits, personal behaviours, and lifestyle related to risks.

• Environmental assessments at work sites identifies existing and potential health and safety hazards – date on worker injury and illness data


Assessment Tools


Health Risk appraisals

Workplace walk-through reports

Employee health and safety records

Case management reports

Interviews with employees & management

Health Insurance claims

Workers compensation forms

Medical utilizations data.



• What is the health of your employee population?

• Program planning is the recipe for the implementing health services goals and objectives



• Currently Nova Scotia is one of the unhealthiest provinces.

• Nova Scotia has the second lowest life expectancy in Canada. It has the second highest rate in deaths.

• It has the highest rate in cancer deaths, breast cancer deaths and respiratory (lung) deaths.

• It has the second highest rate in circulatory deaths (heart) and lung cancer deaths.

• The health status for Nova Scotia is that is has the highest rate of arthritis/rheumatism, diabetes, self reported fair/poor health and self-reported functional problems (Power, 2001).


Health Determinants

• What determines an individual’s health is

based on their social-economic environment, their physical environment, their individual

capacity and coping skills, their personal health practices and their access to a trusted health care provider and health services (Power, 2001).


Federation of Occupational Health Nurses within the European Union - Est.1993


Statistics - AAOHN

Workers' Compensation Costs average $100,000 per 100 full-time workers per year (Bureau of Labor Statistics, 9/07). Full-time workers are defined as those working 2,000 hours a year.

Health Care Insurance Costs average $3,780 per full-time employee per year. This annualized figure was derived from a Bureau of Labor Statistics, 9/07 average of $1.89 per hour x 2,000 hours.

Lost Work Time Cases average 4.4 cases per 100 full-time employees per year (Bureau of Labor Statistics, 9/07).

Our Calculations

Workers' Compensation calculation: [100 / # of FT empl.] x [Total WC Cost per Year]

Health Care Costs: Direct comparison to average, no calculation required.

Lost Work Time Cases calculation: [100 / # of FT empl.] x [Total no. of cases].


Nurses – The best at Caring


Did you know

• All nurses are leaders – 1 in every 70 people are nurses.


Who Supports The OHN in the Workplace?

• Workers Compensation Act

• Occupational Health and Safety Act

• College of Nursing – Protecting the public through professional standards

• Canadian Nurses Protective Society

• Union


Nursing Facts

1 in 40 nurses end up in court (2006) - BUT


Excellent Nursing Care

Nursing Litigation Issues are:

1. Failure to communicate

2. Inadequate patient assessment 3. Medication Errors

4. Unsafe and improper equipment use.

Reference Chris Rokosh, Litigation Stress in Nurses: A literature review and survey.


Where did I learn these traits?

• All I really need to know I learned in


(Reference: Robert Fulghum)



Share everything

Play fair

Don’t hit people

Put things back where you found them

Clean up your own mess

Don’t take things that aren’t yours

Say your sorry when you hurt somebody.



• Wash your hands before you eat

• Flush

• Warm cookies and milk are good for you

• Live a balance life – learn some and think some and draw and paint and sing and dance and play and work every day some

• Take an afternoon nap



• When you go out into the world, watch out for traffic, hold hands, and stick together.

• Wonder.

• The biggest word of all LOOK.

• If all governments had a basic policy to always put things back where they found them and to clean up their own mess – just think what it would be like.


Adult Rules

Drive sober

Buckle up

Wear the gear

Get trained

Look before you move


Qualities of an OHN (8 attitudes of leadership)

Lively intellectual curiosity .

Genuine interest in what other people think .

Feeling of special responsibility to envision a future that is different from what has been done in the past.

A hunch that most risks are there not be avoided but to be taken.

A mindset that crises are normal and tension is a good thing.

A realization that paranoia and self-pity are reserved for people who don’t want to be leaders.

A sense of personal responsibility for the general outcome of your efforts.

Unwarranted optimism.

1 Cleveland, H. (2002) Nobody in Charge: Essays on the Future of Leadership; San Francisco: Jossey- Bass.



• The economic stimulus package means 2.5 million construction worker physicals, drug screens, and work compensation injury care.

• Is your workplace ready for Occupational Health Nursing and Occupational Health Medicine?


11 Magic things I have learned as an OHN

Health and Safety come hand in hand

Challenge = opportunity

Trust your instincts/gut

Listen to your colleagues and employees

Make your boss look good

If you don't ask you don't get

Listen, learn, network

Work through others

Change can be managed

You can make a difference

Nothing ventured nothing gained.



• No matter how old you are – when you go out into the world, it is best to hold hands and stick together.

• When you are ripe you rot when your green you grow…..

Robert Fulghum




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